Provider Demographics
NPI:1083399711
Name:SCHOCK, KASEY (DMD)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:SCHOCK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3416 BRYANT MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-5902
Mailing Address - Country:US
Mailing Address - Phone:313-673-6482
Mailing Address - Fax:
Practice Address - Street 1:578 S ENOTA DR NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-8947
Practice Address - Country:US
Practice Address - Phone:770-536-3254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1230941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice